Tanthauzo la Intertrochanteric Fractures of the Femur
Intertrochanteric fractures ya femur (yomwe imadziwikanso kuti trochanteric fractures) imatanthawuza fractures zomwe zimachitika kuchokera kumunsi kwa khosi lachikazi mpaka pamtunda pamwamba pa trochanter yaying'ono. The mawonetseredwe monga ululu m`deralo, kutupa, ecchymosis. Odwala sangathe kuyenda, ndi kufupikitsa, kulowetsa, ndi kuzungulira kwakunja kwa chiwalo chokhudzidwa, ndi kuyenda kochepa kwa mgwirizano wa chiuno.
Ziphuphuzi zimakhala ndi 3% - 4% ya fractures zonse m'thupi ndi 35.7% ya kuphulika kwa chiuno. Chiwerengerochi chikuwonjezeka ndi zaka, kukhala chofala kwambiri mwa anthu opitirira zaka 70, komanso chofala kwambiri mwa amayi kusiyana ndi amuna.
Anatomy Yogwiritsidwa Ntchito ya Intertrochanteric Fractures of the Femur
Triangle ya Ward
Malo osatetezeka a triangular amapangidwa pakatikati pomwe khosi lachikazi la trabeculae limadutsa. Okalamba omwe ali ndi matenda osteoporosis, malowa amangodzaza ndi mafuta.
Femoral Calcar
A wandiweyani fupa mbale yomwe ili chakumbuyo - pakati pa mphambano ya khosi lachikazi ndi kutsinde lakuya kwa trochanter yaying'ono. Ndiwowonjezera kwa posterior - medial cortex ya femoral shaft mu fupa loyimitsa ndipo ndiye malo ogwiritsira ntchito eccentric katundu pa proximal femur.
Maphunziro a Hip Bone Trabeculae
Kuwerengera mphamvu yamakina a proximal femur:
(1) Gulu 6; (2) Sitandade 5; (3) Gulu 4; (4) Gulu 3; (5) Gulu 2; (6) Gulu 1
Njira Zovulaza za Intertrochanteric Fractures za Femur
Kuvulala Kwamphamvu Kwambiri kwa Odwala Achinyamata
Intertrochanteric fractures mwa odwala achichepere nthawi zambiri amayamba chifukwa cha kuvulala kwakukulu kwamphamvu monga kugwa kuchokera pamtunda komanso ngozi zagalimoto. Izi zingayambitse kuthyoka koopsa, ndipo odwala amafunika kuyang'aniridwa mosamala chifukwa cha kuvulala komwe kumachitika, kuphatikizapo kumutu, msana, ndi ziwalo za thoracic ndi m'mimba.
Zomwe Zimayambitsa Kugwa kwa Odwala Okalamba
90% ya intertrochanteric fractures mwa okalamba amayamba chifukwa cha kugwa. Zinthu zomwe zimapangitsa kuti okalamba ayambe kugwa ndi monga kusawona bwino, kufooka kwa minofu, kuthamanga kwa magazi kosakhazikika, kuchepa kwa mphamvu yochita zinthu, matenda a mitsempha, matenda a mafupa ndi mafupa.
Kaya kugwa kumayambitsa kusweka kumatsimikiziridwa ndi zifukwa zisanu zotsatirazi: kuopsa kwa matenda a osteoporosis, njira ya kugwa, makamaka pamene chiuno kapena malo omwe ali pafupi ndi chiuno akugunda pansi, kusakwanira kwa zodzitetezera kumachepetsa mphamvu ya kugwa, kulephera kwa minofu yofewa ya m'chiuno kuti itenge mphamvu zokwanira, ndi kuchepa kwa mphamvu ya mafupa a m'chiuno.
Mitundu ya Nkhanza ndi Njira Zochitira
Chiwawa Chachindunji: Kuvulala kwakukulu kwamphamvu kumachita mwachindunji m'chiuno, monga ngozi zapamsewu kapena kugwa komwe ntchafu imakhudzidwa mwachindunji, zomwe zimapangitsa kuti ziphwanyike.
Nkhanza Zachindunji: Kugwedezeka kwa thupi kumapangitsa kuti chiuno chikhale cha varus ndi kupititsa patsogolo kupsinjika maganizo. Ndi trochanter yaying'ono ngati fulcrum, imapanikizidwa mwamphamvu, ndipo pangakhalenso mphamvu yokoka ya minofu ya iliopsoas, kupanga gulugufe - chidutswa cha fupa. The trochanter yaikulu ingapangitsenso fupa lolekanitsidwa chifukwa cha kukoka mwamphamvu kwa gluteus medius minofu.
Gulu Lachipatala la Intertrochanteric Fractures of the Femur
Evans Gulu
Ambiri ntchito matenda kuchita. Evans adagawa ma intertrochanteric fractures kukhala mitundu iwiri:
Type I: Trans - trochanteric fractures Malinga ndi kukhazikika kusanachitike komanso kuchepetsedwa, imagawidwanso mu 4 subtypes:
Ⅰa: Kusweka kwa magawo awiri popanda kusamutsidwa.
Ⅰb: Magawo awiri ophwanyika ndi kusamuka, cortex yapakati imakhala yosasunthika, ndipo fracture imakhala yokhazikika ikachepetsedwa.
Ⅰc: The trochanter yaying'ono ndi yaulere, yokhala ndi fracture displacement ndi varus deformity; kapena trochanter yaikulu ndi fupa lapadera.
Ⅰd: Kuphatikiza pa kupasuka kwa intertrochanteric, ma trochanters akuluakulu ndi ang'onoang'ono amakhala zidutswa za mafupa osiyana, ndi kuwonongeka kwa varus.
Mwa iwo, mitundu Ⅰa ndi Ⅰb ndi mitundu yokhazikika, ndipo ena onse ndi osakhazikika.
Mtundu Wachiwiri: Kubwereranso - oblique intertrochanteric fractures
Mtundu wachiwiri ndi fracture - trochanteric fracture, ndi mzere wa fracture ukukwera mosalekeza kuchokera pansi pa trochanter yaikulu kupita kumtunda kwa trochanter yaying'ono.
Gulu la AO
Mtundu A1: Zosavuta ziwiri - magawo amathyoka kudzera mu trochanter, mothandizidwa bwino ndi fupa lapakati la fupa lapakati ndi fupa la lateral cortex.
Pakati pa mzere wa intertrochanteric.
Kupyolera mu trochanter wamkulu.
Kupyolera mu trochanter yaying'ono.
Mtundu A2: Kuphulika kwapang'onopang'ono kupyolera mu trochanter, ndi fractures ya medial cortex mu ndege ziwiri, koma lateral bone cortex imakhalabe.
Ndi chidutswa chimodzi chapakati chophwanyika.
Ndi zidutswa zingapo zapakati zosweka.
Kukula kuposa 1 cm pansi pa trochanter yaying'ono.
Mtundu A3: Kubwerera kumbuyo - intertrochanteric fractures, ndi fractures ya lateral cortex komanso.
Oblique.
Chodutsa.
Kudzipereka.
Nthawi zambiri, mitundu A1.1 mpaka A2.1 imaonedwa kuti ndi yokhazikika, ndipo mitundu A2.2 mpaka A3.3 imaonedwa kuti ndi yosakhazikika.
Chithandizo cha Opaleshoni ya Intertrochanteric Fractures ya Femur
Cholinga chachikulu cha chithandizo cha opaleshoni ndicho kukwaniritsa kukhazikika kwa intertrochanteric fracture pambuyo pochepetsa. Kukhazikika kwa kukhazikika kumadalira pazifukwa zotsatirazi: khalidwe la fupa, mtundu wa fracture, kuchepetsa, mapangidwe a chipangizo chokonzekera mkati, ndi malo osungiramo zinthu zamkati.
M'zaka zaposachedwa, zida zopangira mkati zochizira fractures za intertrochanteric zakhala zikupangidwa ndikusinthidwa mosalekeza. Mwa iwo, intramedullary fixation, monga PFNA ndi INTERTAN, imagwiritsidwa ntchito ngati chipangizo chokhazikika chamkati.
PFNA ya Chithandizo cha Intertrochanteric Fractures of the Femur
PFNA imagwiritsidwa ntchito popanga mafupa osakhazikika a osteoporotic intertrochanteric monga Evans Ic, Id, ndi Type II. Imakhala ndi magwiridwe antchito abwino, luso loletsa kusinthasintha, nthawi yaying'ono yochita opaleshoni, kutaya magazi pang'ono, zovuta zochepa, komanso mwayi wocheperako wodula misomali yotsekera, zomwe zikuwonetsa ubwino wa chithandizo.
PFNA imasonyezedwa chifukwa chosakhazikika cha osteoporotic intertrochanteric fractures (monga Evans mitundu Ic, Id, ndi II). Imawonetsa magwiridwe antchito apamwamba kwambiri okhala ndi anti-rotation properties, nthawi yayitali yogwirira ntchito, kuchepa kwa magazi, komanso zovuta zochepa. Kapangidwe ka helical blade kachitidwe kameneka kamaphatikizana bwino ndi fupa, kupereka mphamvu zogwira mwamphamvu ndikuchepetsa kwambiri chiopsezo chodulidwa kuchokera kumutu wachikazi, kupereka zabwino zake zochiritsira.
INTERTAN ya Chithandizo cha Intertrochanteric Fractures of the Femur
Ndi chitukuko chaukadaulo wamakono wazachipatala, INTERTAN ndi mtundu watsopano wa msomali wa intramedullary womwe umapangidwira makamaka pochiza fractures ya intertrochanteric ya femur. Mtanda - gawo la msomali wake waukulu ndi trapezoidal. Mukagwiritsidwa ntchito limodzi ndi misomali yolumikizana yolumikizana, imatha kuletsa 'Z' zotsatira. Kuwonjezeredwa kwa msomali wachiwiri wotuluka pamutu wa chikazi kumawonjezera anti - rotational effect ya lag screw. Izi msomali intramedullary ali osiyanasiyana ntchito ndipo ndi oyenera odwala kwambiri osteoporosis.
INTERTAN ndi buku la intramedullary msomali wopangidwa makamaka kuti aziphwanyidwa pakati pa ma intertrochanteric, akuwonetsa kupita patsogolo kwaukadaulo wamakono wazachipatala. Msomali wake waukulu umakhala ndi gawo la trapezoidal kuti likhale lokhazikika. Gawo la proximal limagwiritsa ntchito chomangira chophatikizika chophatikizika (zowononga ndi screw), zomwe zimalepheretsa 'Z-effect' (pamene wononga imodzi imatuluka pomwe ina imalowa mumutu wa chikazi). Chowonjezera chowonjezera chimalola kuti scrack ya lag igwire ntchito mkati mwa mutu wa chikazi, ndikuwonjezera mphamvu yake yotsutsa kuzungulira. Msomali uwu uli ndi zizindikiro zambiri ndipo ndi woyenera makamaka kwa odwala matenda osteoporosis.
Malingaliro a kampani CHANGZHOU MEDITECH TECHNOLOGY CO., LTD. imakhazikika pamakina opangira mafupa amphamvu kwambiri komanso njira zopangira opaleshoni zapamwamba. Ndi bizinesi yapamwamba kwambiri yophatikiza R&D, kupanga, kugulitsa, ndi ntchito.
Kutsatira malingaliro a 'Innovation Driven, Pursuit of Excellence,' zomwe kampaniyo imapanga zimakwirira msana, misomali ya intramedullary, mbale zokhoma, zolumikizira zakunja, zolumikizira, craniomaxillofacial, veterinary, zida zamagetsi, zida zoyambira, ndi mabuloni. Mizere yazinthuzi ikuyimira madera ofunikira pazatsopano zamakono m'makampani azachipatala, odzipereka kuti apereke njira zowonjezera komanso zodalirika za opaleshoni yapadziko lonse lapansi. Ndi mitundu yake yamitundu yosiyanasiyana komanso luso lolimba, kampaniyo imalimbikitsa kupititsa patsogolo komanso kupezeka kwaukadaulo wazachipatala.
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